The Role of 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in the Diagnosis of Left-sided Endocarditis: Native vs Prosthetic Valves Endocarditis

• Published in: Clinical infectious diseases Vol. 70; no. 4; pp. 583 - 594
• Main Authors: de Camargo, Raphael Abegão, Sommer Bitencourt, Marcio, Meneghetti, José Claudio, Soares, Jose, Gonçalves, Luís Fernando Tonello, Buchpiguel, Carlos Alberto, Paixão, Milena Ribeiro, Felicio, Marilia Francesconi, de Matos Soeiro, Alexandre, Varejão Strabelli, Tania Mara, Mansur, Alfredo Jose, Tarasoutchi, Flavio, Tavares de Oliveira, Mucio, Bianchi Castelli, Jussara, Menosi Gualandro, Danielle, Zoboli Pocebon, Lucas, Blankstein, Ron, Alavi, Abass, Moore, John Edmund, Millar, Beverley Cherie, Focaccia Siciliano, Rinaldo
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 03-02-2020
• Subjects: Endocarditis - diagnostic imaging; Endocarditis, Bacterial - diagnostic imaging; Fluorodeoxyglucose F18; Heart Valve Prosthesis - adverse effects; Humans; Positron Emission Tomography Computed Tomography; Prosthesis-Related Infections - diagnostic imaging; Radiopharmaceuticals; positron-emission tomography; endocarditis; prosthetic heart valve; heart valve; F-fluorodeoxyglucose; 18F-fluorodeoxyglucose
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1093/cid/ciz267

Abstract
Background
18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) has emerged as a useful diagnostic tool for suspected infective endocarditis (IE) in patients with prosthetic valves or implantable devices. However, there is limited evidence regarding use of 18F-FDG-PET/CT for the diagnosis of native valve endocarditis (NVE).
Methods
Between 2014 and 2017, 303 episodes of left-sided suspected IE (188 prosthetic valves/ascending aortic prosthesis and 115 native valves) were studied. 18F-FDG-PET/CT accuracy was determined in the subgroups of patients with NVE and prosthetic valve endocarditis (PVE)/ascending aortic prosthesis infection (AAPI). Associations between inflammatory infiltrate patterns and 18F-FDG-PET/CT uptake were investigated in an exploratory ad hoc histological analysis.
Results
Among 188 patients with PVE/AAPI, the sensitivity, specificity, and positive and negative predictive values of 18F-FDG-PET/CT focal uptake were 93%, 90%, 89%, and 94%, respectively, while among 115 patients with NVE, the corresponding values were 22%, 100%, 100%, and 66%. The inclusion of abnormal 18F-FDG cardiac uptake as a major criterion at admission enabled a recategorization of 76% (47/62) of PVE/AAPI cases initially classified as “possible” to “definite” IE. In the histopathological analysis, a predominance of polymorphonuclear cell inflammatory infiltrate and a reduced extent of fibrosis were observed in the PVE group only.
Conclusions
Use of 18F-FDG-PET/CT at the initial presentation of patients with suspected PVE increases the diagnostic capability of the modified Duke criteria. In patients who present with suspected NVE, the use of 18F-FDG-PET/CT is less accurate and could only be considered a complementary diagnostic tool for a specific population of patients with NVE.
18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) is an additional diagnostic tool for suspected infective endocarditis (IE) in patients with prosthetic valves. To our knowledge, there is limited evidence regarding the use of 18F-FDG-PET/CT for the diagnosis of native valve IE.